Originally published as JCO Early Release 10.1200/JCO.2003.02.046 on August 11 2003

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bouchardy, C. Articles by Vlastos, G. Search for Related Content PubMed PubMed Citation Articles by Bouchardy, C. Articles by Vlastos, G. Social Bookmarking                            What's this?

Undertreatment Strongly Decreases Prognosis of Breast Cancer in Elderly Women

Christine Bouchardy, Elisabetta Rapiti, Gérald Fioretta, Paul Laissue, Isabelle Neyroud-Caspar, Peter Schäfer, John Kurtz, André-Pascal Sappino, Georges Vlastos

From the Geneva Cancer Registry, Institute for Social and Preventive Medicine, Geneva University; Clinic of Gynecology, Senology, Department of Obstetrics and Gynecology; Division of Radiation Oncology; Department of Radiology; and Division of Oncology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.

Address reprint requests to Christine Bouchardy, MD, Geneva Cancer Registry, 55 Boulevard de la Cluse 55, 1205 Geneva, Switzerland; e-mail: christine.bouchardymagnin{at}imsp.unige.ch.

Purpose: No consensus exists on therapy of elderly cancer patients. Treatments are influenced by unclear standards and are usually less aggressive. This study aims to evaluate determinants and effect of treatment choice on breast cancer prognosis among elderly patients.

Patients and Methods: We reviewed clinical files of 407 breast cancer patients aged 80 years recorded at the Geneva Cancer Registry between 1989 and 1999. Patient and tumor characteristics, general health status, comorbidity, treatment, and cause of death were considered. We evaluated determinants of treatment by logistic regression and effect of treatment on mortality by Cox model, accounting for prognostic factors.

Results: Age was independently linked to the type of treatment. Overall, 12% of women (n = 48) had no treatment, 32% (n = 132) received tamoxifen only, 7% (n = 28) had breast-conserving surgery only, 33% (n = 133) had mastectomy, 14% (n = 57) had breast-conserving surgery plus adjuvant therapy, and 2% (n = 9) received miscellaneous treatments. Five-year specific breast cancer survival was 46%, 51%, 82%, and 90% for women with no treatment, tamoxifen alone, mastectomy, and breast-conserving surgery plus adjuvant treatment, respectively. Compared with the nontreated group, the adjusted hazard ratio of breast cancer mortality was 0.4 (95% CI, 0.2 to 0.7) for tamoxifen alone, 0.4 (95% CI, 0.1 to 1.4) for breast-conserving surgery alone, 0.2 (95% CI, 0.1 to 0.7) for mastectomy, and 0.1 (95% CI, 0.03 to 0.4) for breast-conserving surgery plus adjuvant treatment.

Conclusion: Half of elderly patients with breast cancer are undertreated, with strongly decreased specific survival as a consequence. Treatments need to be adapted to the patient’s health status, but also should offer the best chance of cure.

Presented as a poster at the 25th San Antonio Breast Cancer Symposium, December 11–14, 2002.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. G. D. Porta and L. Malcovati Clinical relevance of extra-hematologic comorbidity in the management of patients with myelodysplastic syndrome Haematologica, May 1, 2009; 94(5): 602 - 606. [Full Text] [PDF]

				M. A. Schonberg and E. P. McCarthy Mammography Screening Among Women Age 80 Years and Older: Consider the Risks J. Clin. Oncol., February 1, 2009; 27(4): 640 - 641. [Full Text] [PDF]

				V. Girre, M.-C. Falcou, M. Gisselbrecht, G. Gridel, V. Mosseri, C. Bouleuc, R. Poinsot, L. Vedrine, L. Ollivier, V. Garabige, et al. Does a Geriatric Oncology Consultation Modify the Cancer Treatment Plan for Elderly Patients? J Gerontol A Biol Sci Med Sci, July 1, 2008; 63(7): 724 - 730. [Abstract] [Full Text] [PDF]

				H. B. Muss, D. Tu, J. N. Ingle, S. Martino, N. J. Robert, J. L. Pater, T. J. Whelan, M. J. Palmer, M. J. Piccart, L. E. Shepherd, et al. Efficacy, Toxicity, and Quality of Life in Older Women With Early-Stage Breast Cancer Treated With Letrozole or Placebo After 5 Years of Tamoxifen: NCIC CTG Intergroup Trial MA.17 J. Clin. Oncol., April 20, 2008; 26(12): 1956 - 1964. [Abstract] [Full Text] [PDF]

				I. Boncz, A. Sebestyen, I. Pinter, J. Betlehem, I. Kriszbacher, T. Csere, L. Mangel, and J. Bodis Age Group Specific Gap Between Treatment Cost of and Mortality Due to Breast and Colorectal Cancer J. Clin. Oncol., October 1, 2007; 25(28): 4501 - 4502. [Full Text] [PDF]

				G Mustacchi, M. Cazzaniga, P Pronzato, A De Matteis, F Di Costanzo, I Floriani, and On behalf of the NORA Study Group Breast cancer in elderly women: a different reality? Results from the NORA study Ann. Onc., June 1, 2007; 18(6): 991 - 996. [Abstract] [Full Text] [PDF]

				M. Extermann and A. Hurria Comprehensive Geriatric Assessment for Older Patients With Cancer J. Clin. Oncol., May 10, 2007; 25(14): 1824 - 1831. [Abstract] [Full Text] [PDF]

				C. Bouchardy, E. Rapiti, S. Blagojevic, A.-T. Vlastos, and G. Vlastos Older Female Cancer Patients: Importance, Causes, and Consequences of Undertreatment J. Clin. Oncol., May 10, 2007; 25(14): 1858 - 1869. [Abstract] [Full Text] [PDF]

				C. Terret, G. B. Zulian, A. Naiem, and G. Albrand Multidisciplinary Approach to the Geriatric Oncology Patient J. Clin. Oncol., May 10, 2007; 25(14): 1876 - 1881. [Abstract] [Full Text] [PDF]

				D. Crivellari, M. Aapro, R. Leonard, G. von Minckwitz, E. Brain, A. Goldhirsch, A. Veronesi, and H. Muss Breast Cancer in the Elderly J. Clin. Oncol., May 10, 2007; 25(14): 1882 - 1890. [Abstract] [Full Text] [PDF]

				I. Jatoi, B. E. Chen, W. F. Anderson, and P. S. Rosenberg Breast Cancer Mortality Trends in the United States According to Estrogen Receptor Status and Age at Diagnosis J. Clin. Oncol., May 1, 2007; 25(13): 1683 - 1690. [Abstract] [Full Text] [PDF]

				G. Vlastos and H. M. Verkooijen Minimally Invasive Approaches for Diagnosis and Treatment of Early-Stage Breast Cancer Oncologist, January 1, 2007; 12(1): 1 - 10. [Abstract] [Full Text] [PDF]

				D. A. Litvak and R. Arora Treatment of Elderly Breast Cancer Patients in a Community Hospital Setting Arch Surg, October 1, 2006; 141(10): 985 - 990. [Abstract] [Full Text] [PDF]

				L. C. Richardson, L. Tian, L. Voti, A. G. Hartzema, I. Reis, L. E. Fleming, and J. MacKinnon The Roles of Teaching Hospitals, Insurance Status, and Race/Ethnicity in Receipt of Adjuvant Therapy for Regional-Stage Breast Cancer in Florida Am J Public Health, January 1, 2006; 96(1): 160 - 166. [Abstract] [Full Text] [PDF]

				T. Fisch, P. Pury, N. Probst, A. Bordoni, C. Bouchardy, H. Frick, G. Jundt, D. De Weck, E. Perret, and J.-M. Lutz Variation in survival after diagnosis of breast cancer in Switzerland Ann. Onc., December 1, 2005; 16(12): 1882 - 1888. [Abstract] [Full Text] [PDF]

				A. Brunello, U. Basso, C. Pogliani, A. Jirillo, C. Ghiotto, H. Koussis, F. Lumachi, M. Iacobone, L. Vamvakas, and S. Monfardini Adjuvant chemotherapy for elderly patients (>=70 years) with early high-risk breast cancer: a retrospective analysis of 260 patients Ann. Onc., August 1, 2005; 16(8): 1276 - 1282. [Abstract] [Full Text] [PDF]

				C. Alliot Undertreatment of Breast Cancer in Elderly Women: Contribution of a Cancer Registry J. Clin. Oncol., July 20, 2005; 23(21): 4800 - 4801. [Full Text] [PDF]

				P. Fargeot In Reply: J. Clin. Oncol., June 20, 2005; 23(18): 4238 - 4239. [Full Text] [PDF]

				A. J. ten Tije, J. Verweij, M. A. Carducci, W. Graveland, T. Rogers, T. Pronk, M.P. Verbruggen, F. Dawkins, and S. D. Baker Prospective Evaluation of the Pharmacokinetics and Toxicity Profile of Docetaxel in the Elderly J. Clin. Oncol., February 20, 2005; 23(6): 1070 - 1077. [Abstract] [Full Text] [PDF]

				R. A. Silliman What Constitutes Optimal Care for Older Women With Breast Cancer? J. Clin. Oncol., October 1, 2003; 21(19): 3554 - 3556. [Full Text] [PDF]